School-Based Health Center Case Study: 14 year old with vape usage and is unsure of quitting

Background

Patient Information

14 y/o Caucasian female in clinic for a routine annual visit

Initial Vitals: RR =14; BP=110/70 mm Hg, Temp= 98.6

Meds:

• None

HPI(History of Present Illness):

• She lives with her father and has no siblings.
• Patient is generally well appearing with no major health concerns.

Other Info:

• Heterosexual; pronouns: she/her

Ask

Screen for Tobacco Use With Every Youth Age 11+ at Every Clinical Encounter.

* Products used may vary between communities. Visit the Considerations for Clinicians page to view illustrations of common products.

Create a Space for Confidentiality & Trust

Sample Dialogue Part 1 of 4

Clinician: Do any of your family use tobacco or vape products?

Patient: Not that I know of.

Clinician: What about you. Do you use any tobacco or vaping products, like cigarettes, e-cigarettes, pods, vapes, or dip?

Patient: Yeah, everybody at school vapes.

Clinician: How often do you vape?

Patient: Almost everyday, it’s no big deal.

Clinician: I appreciate you being honest and sharing that with me.

Counsel

Counsel All Patients Who Use Tobacco About Quitting, Regardless of Amount or Frequency of Use.

Sample Dialogue Part 2 of 4

Clinician: As your doctor, I care about you and I want to help you stay as healthy as possible. Because your brain is still developing, it’s not safe for you to use any tobacco or nicotine product, including e-cigarettes.

Patient: I thought e-cigarettes didn’t have nicotine –just water and flavoring?

Clinician: Most e-cigarettes have nicotine. There are also other chemicals in them that can be harmful. When you vape, you’re inhaling those chemicals, like heavy metals and other chemicals that can cause cancer, into your lungs."

Patient: Oh.

Clinician: Are you interested in quitting today?”

Patient: I’m not sure.

If the Youth is Unsure or Not Ready to Quit

Sample Dialogue Part 3 of 4

Clinician: I appreciate you being honest with me. Quitting is hard, but I believe when you’re ready you can do it. Can you think of any benefits to quitting?

Patient: Well, you said I’m inhaling heavy metals, so I guess stopping would help.

Clinician: Yes, that is true. The nicotine in your vape pen can also harm your brain development.

Patient: Oh.

Clinician: Can you think of any reasons it would be hard to quit?

Patient: A lot of my friends vape, so it might be weird if I stopped.

Sample Dialogue Part 4 of 4

Clinician: I can understand that. Maybe, when you decide to quit, you can tell a few close friends who might be willing to help–or even quit with you.

Patient: I mean… maybe. I don’t know.

Clinician: Have you ever tried to cut down or quit before?

Patient: I’ve cut down for a few days before.

Clinician: That’s good to know. Can I talk with you more about cutting down again or stopping entirely?

Patient: No, I’m not really interested in quitting right now, maybe next time.

Clinician: Okay, I understand. We’ll talk more about it at your next visit. If you decide before then that you'd like to try to quit, please reach out. I'm here when you're ready.

Patient: Okay, thank you.

Treat

When Youth is Ready to Make a Quit Attempt

Cessation Support & Additional Follow Up

* Inpatient Case Study 2 explores the use of NRT in tobacco users < 18 years old.

**AAP Recommendations for NRT Prescription can be found at aap.org/NRT

Download Full Case Study View Full Youth Clinical Considerations

Additional case studies were developed to show the variations in clinical settings, common products, screening techniques, motivational interviewing, patient response, and clinician considerations. Please return to the home page to see additional case studies.